| NPI | 1346890308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-003645) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1354) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2019-09-12 |